Contextual Autocomplete: A Novel User Interface Using Machine Learning to Improve Ontology Usage and Structured Data Capture for Presenting Problems in the Emergency Department

Abstract

ObjectiveTo determine the effect of contextual autocomplete, a user interface that uses machine learning, on the efficiency and quality of documentation of presenting problems (chief complaints) in the emergency department (ED).\n\nMaterials and MethodsWe used contextual autocomplete, a user interface that ranks concepts by their predicted probability, to help nurses enter data about a patients reason for visiting the ED. Predicted probabilities were calculated using a previously derived model based on triage vital signs and a brief free text note. We evaluated the percentage and quality of structured data captured using a prospective before-and-after study design.\n\nResultsA total of 279,231 patient encounters were analyzed. Structured data capture improved from 26.2% to 97.2% (p<0.0001). During the post-implementation period, presenting problems were more complete (3.35 vs 3.66; p=0.0004), as precise (3.59 vs. 3.74; p=0.1), and higher in overall quality (3.38 vs. 3.72; p=0.0002). Our system reduced the mean number of keystrokes required to document a presenting problem from 11.6 to 0.6 (p<0.0001), a 95% improvement.\n\nDiscussionWe have demonstrated a technique that captures structured data on nearly all patients. We estimate that our system reduces the number of man-hours required annually to type presenting problems at our institution from 92.5 hours to 4.8 hours.\n\nConclusionImplementation of a contextual autocomplete system resulted in improved structured data capture, ontology usage compliance, and data quality.